Angelo d'Errico1, Cristiano Piccinelli1,2, Gabriella Sebastiani3, Fulvio Ricceri1,4, Veronica Sciannameo1, Moreno Demaria5, Paola Di Filippo3, Giuseppe Costa4. 1. Epidemiology Department, Local Health Unit TO3, Piedmont Region, Grugliasco, Turin, Italy. 2. Center for Epidemiology and Prevention in Oncology, Città della Salute e della Scienza, Turin, Italy. 3. National Institute of Statistics, Rome, Italy. 4. Department of Clinical and Biological Sciences, University of Turin, Turin, Italy. 5. Department of Environmental Epidemiology, Piedmont Environmental Protection Agency, Turin, Italy.
Abstract
BACKGROUND: Aim of this study was to examine the association between unemployment and mortality, taking into account potential confounders of this association. A secondary objective was to assess whether the association between unemployment and mortality was modified by lack of household economic resources. METHODS: Prospective cohort composed of a representative sample of Italian subjects 30-55 years who participated in the Italian National Health Survey 1999-2000, followed up for mortality up to 2012 (15 656 men and 11 463 women). Data were analyzed using Cox regression models, stratified by gender and adjusted for health status, behavioral risk factors, socioeconomic position and position in the household. The modifying effect of the lack of economic resources was assessed by testing its interaction with unemployment on mortality. RESULTS: Among women, unemployment was not associated with mortality, whereas among men, higher mortality was found from all causes (HR = 1.82), which was not modified by lack of economic resources, and from neoplasms (HR = 1.59), cardiovascular diseases (HR = 2.58) and suicides (HR = 5.01). CONCLUSIONS: Results for men were robust to the adjustment for main potential confounders, suggesting a causal relationship between unemployment and mortality. The lack of effect modification by economic resources supports the relevance of the loss of non-material benefits of work on mortality.
BACKGROUND: Aim of this study was to examine the association between unemployment and mortality, taking into account potential confounders of this association. A secondary objective was to assess whether the association between unemployment and mortality was modified by lack of household economic resources. METHODS: Prospective cohort composed of a representative sample of Italian subjects 30-55 years who participated in the Italian National Health Survey 1999-2000, followed up for mortality up to 2012 (15 656 men and 11 463 women). Data were analyzed using Cox regression models, stratified by gender and adjusted for health status, behavioral risk factors, socioeconomic position and position in the household. The modifying effect of the lack of economic resources was assessed by testing its interaction with unemployment on mortality. RESULTS: Among women, unemployment was not associated with mortality, whereas among men, higher mortality was found from all causes (HR = 1.82), which was not modified by lack of economic resources, and from neoplasms (HR = 1.59), cardiovascular diseases (HR = 2.58) and suicides (HR = 5.01). CONCLUSIONS: Results for men were robust to the adjustment for main potential confounders, suggesting a causal relationship between unemployment and mortality. The lack of effect modification by economic resources supports the relevance of the loss of non-material benefits of work on mortality.
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Authors: Elena Strippoli; Amanda Hughes; Gabriella Sebastiani; Paola Di Filippo; Angelo d'Errico Journal: Int Arch Occup Environ Health Date: 2021-10-11 Impact factor: 3.015
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